Breaking the code: How seeking help can save lives

By Andrea Poncia

Health promotion campaigns often highlight the negative impacts of a harmful behaviour, and then provide information about healthier alternatives. It’s an approach that assumes the audience is capable of changing habits and behaviours, and it works best for things that are fairly easy to change, like wearing seat belts.

Unfortunately, this approach can sometimes have the opposite effect. For example, youth who feel suicidal are less likely to seek help, and experience greater distress after being exposed to this type of campaign. To support suicide prevention planning, the Province of Manitoba developed that outline the harms of focusing on shock and trauma, and discuss how to constructively address suicide among youth. A similar theme of caution about fear- based messaging comes from the Canadian Association of Suicide Prevention’s about how to report on suicide in the media.

While there is little evidence that negative messaging promotes behaviour change in relation to suicide, there is consensus that suicide prevention efforts should focus on identifying people who are at-risk, and promoting help-seeking. For example, in 2015, 13% of high school students surveyed in Ottawa seriously considered suicide, and of these, 71% didn’t know where to turn. To address this, a cross-sectoral group of organizations set-out to identify programs that could be implemented to reach and engage vulnerable youth. These organizations came together through the Community Suicide Prevention Network (CSPN) that led a process to identify an evidence-informed practice to promote help-seeking.

The CSPN consulted the and Both websites listed a program called Sources of Strength as a promising practice, and, in 2014, Ottawa joined cities throughout the United States and Australia in implementing the program. It is currently being offered in 23 local high schools. While more research is required to better understand , there is promising evidence that it can be a powerful tool to increase help-seeking behaviours.

One of the ways to promote help-seeking is by focusing on relationships. Youth who have suicidal thoughts tend to gravitate to people who have had similar life experiences, so they often engage with peers who have also experienced suicidal thoughts and actions. This can lead to a situation where suicide is seen as a common-place response to crisis. The Sources of Strength program aims to counteract this normalization of suicide by bringing adult and youth leaders together to plan outreach activities in schools with the aims of changing norms about seeking help, promoting resiliency, building relationships between youth and adults, and shifting the perception that suicide is a normal response to crisis.

The program is based on the notion that youth become less vulnerable to suicide when they are integrated within deep and high quality relationships that promote positive norms, such as help-seeking. This is important for a few reasons: one is that relationships play a vital role in helping us navigate choices. Young people’s decisions are highly influenced by the norms within their social groups. Another is that relationships with positive people foster a sense of well-being, and create opportunities for loved ones to notice vulnerability and make connections to services when needed.

To understand the effectiveness of the program, Wyman et. al., evaluated how Sources of Strength impacted the breadth and quality of youth relationships with trusted adults. They also looked at how willing peer leaders would be to get adult help when their peers requested secrecy about their suicidal feelings.

For this study, the Sources of Strength peer leaders worked with adult advisors to develop. These carefully crafted campaigns consisted of class presentations where youth leaders talked about their strengths, and named trusted adults. Adult advisors were present during these sessions to ensure all of these components were included in the youth’s messaging. As health promotion activities are enhanced when there are opportunities for audience participation, peer leaders engaged student participants to do the same.

What they found was promising. Sources of Strength peer leaders were more likely to believe that adults were available to help them in the school. They were more likely to connect their peers with suicidal thoughts to adults, they expressed fewer negative coping mechanisms, and were more engaged within their schools.

What’s more, youth who were suicidal experienced the biggest benefit. As for the youth who were already resilient when they came into their peer leader roles, they were more likely to refer peers to adults than before the program.

Petrova et. al showed that after three months, Sources of Strength led to changes within the whole school population. The greatest shift was in students’ perceptions that there were adults in the school that they could turn to for support. Overall, there was greater acceptance that asking for help was a good thing. Once again, the students who had the most positive changes were those who had suicidal feelings or thoughts.

These results are encouraging considering that currently, most youth only disclose their suicidal thoughts to peers. While more research is needed to build on the studies that only looked at the short term, Sources of Strength offers a promising practice for suicidal youth, known to have fewer deep ties to supportive adults, to learn that it’s ok to ask for help, and to be exposed to opportunities to build resilience. It is likely not the only program that can bring about positive change, but it certainly reinforces the notion that providing positive and effective supports can make a difference.

Bibliography

Ottawa Public Health. Ottawa Student Drug Use and Health Report, 2014. Ottawa (ON): Ottawa Public Health; 2014.

Bennett, K., Cheung, A., Manassis, K., Links, P., Mushquash,C., Braunberger, P., Newton, A. S., Kutcher, S., Bridge, J., Santos, R.G., Manion, I., McLennan, J., Bagnell, A., Lipman, E., Rice, M., Szatmari, P. (2015). A Youth Suicide Prevention Plan for Canada: A Systematic Review of Reviews. Canadian Journal of Psychiatry, 60 (6), 245-257.

Petrova, M., Wyman, P. A., Schmeelk-Cone, K., Pisani, R. A. (2015). Postive-Themed Suicide Prevention Messages Delivered by Adolescent Peer Leaders: Proximal Impact on Classmate’s Coping Attitudes and Perceptions of Adult Support. Suicide and Life Threatening Behaviour, 45 (6),

Pisani, R. A., Schmeelk-Cone, K., Gunzler, D., Petrova, M., Goldston, D. B., Tu, X., Wyman, P. A. (2012). Associations Between Suicidal High School Students’ Help- Seeking and their Attitudes and Perceptions of Social Environment. Journal Youth Adolescence, 41, 1312-1324.

Schmeelk-Cone, K., Pisani, R. A., Petrova, M., Wyman, P. A. (2012). Three Scales Assessing High School Students’ Attitudes and Perceived Norms ĐÓ°ÉÔ­´´ Seeking Adult Help for Distress and Suicide Concerns. Suicide and Life Threatening Behaviour, 42 (2), 157-172.

Wyman, P. A, Brown, H., LoMurray, M., Schmeelk-Cone, K., Petrova, M., Yu, Q., Walsh, E., Tu, X., Wang, W., (2010). An Outcome Evaluation of the Sources of Strength Suicide Prevention Program Delivered by Adolescent Peer Leaders in High Schools. American Journal of Public Health, 100 (9), 1653-1661.

By Josee Beaudry, Department of Psychology, ĐÓ°ÉÔ­´´ University

Christopher Mushquash is Ojibway and a member of Pays Plat First Nation, located on the north shore of Lake Superior. Among many titles, he is a clinical psychologist, Associate Professor in the Department of Psychology at Lakehead University and the Northern Ontario School of Medicine, and a Canada Research Chair in Indigenous Mental Health and Addiction.

His work is very much influenced by his past experiences and who considers himself to be. He tries to use those experiences within his work as both a researcher and a clinician.

Having an Indigenous background and growing up rurally allow him to not only see some of the disparities in health but also the great strength, wisdom, and diversity in culture-based healing approaches. Cultural traditions differ from region to region and to simply force one’s own ideals onto communities is, at best, ineffective in addressing issues and, at worst, can do harm. This mindfulness led him to develop a skill set that would make him useful to people from communities like his own. In general, Mushquash looks into ways of increasing wellness. Through research he hopes to find ways to help people manage difficulties and past experiences. He also hopes to enlighten people about their approach to research and interventions in Indigenous communities.

Mental Health and Overall Wellness
Mushquash is currently addressing a number of research questions with multiple indigenous communities across the country. Some of the main areas he is focusing on include, trying to understand what mental well-being means from the perspective of the First Nations peoples. Perhaps most importantly, what steps must be taken to use that understanding to improve services and help those in need. This understanding starts by viewing mental health less through a mainstream lens and more through culturally-based one.

The most prominent view on well-being is a Western medical approach, often thought of as an absence of illness. Meaning, if you aren’t sick, you’re healthy. Indigenous communities view health more as a balance of various aspects of overall wellness. Depicted by the medicine wheel, an Indigenous view of health and wellness takes on a more holistic perspective.

Physical, mental, emotional, and spiritual health are aspects of one’s overall well-being; there isn’t a specific focus on one or the other. Mushquash suggests that promoting wellness isn’t just about making people who are sick feel better but about nurturing people as a whole. It is this understanding of wellness that he uses to promote change in services from community to community. Communities always find approaches that work best for them. He tries to not dictate what approach they take but rather helps them find and develop their own, based on their own experiences, cultures, and contexts.

A Culture-based Approach

In his talk on Indigenous Youth Mental Health, Mushquash provided examples of issues that arise when applying the same standards across community to community and individually in the diagnosis. Some of the diagnostic criteria can appear to contradict each other, there are many possible combinations of symptom presentations that could lead to diagnosis, and two individuals diagnosed with the same disorder could have different symptom profiles. The truth is there are many individual, cultural, and contextual factors at play in how mental health difficulties are expressed. Misdiagnosis can occur and people may not get the help that they need.

Mushquash and his colleagues’ research on mental health and addiction show that social determinants greatly influence the prevalence and expression of disorders. Genetics, biological factors or brain neurochemicals associated with mental health difficulties are one part of the picture. But poverty, homelessness, access to services, and education also influence mental health. And for many Indigenous groups exposure to colonization practices and assimilation policies have generational and intergenerational effects on mental health. Mushquash and his colleagues try to contextualize Indigenous conceptualizations of wellness within this framework.

Mushquash gives credit to everyone he works with for the research he is a part of and the work he continues to do today. He is proud to work with a lot of great students, and is a great mentor, researcher, and clinician who promotes an Indigenous understanding of wellness. He hopes to one day see fewer misconceptions of well-being and improved health among indigenous populations.